The Complexities of Environmental Health Security

When addressing “environmental health,” many agencies around the world cite the World Health Organization’s definition, but this term still is not widely understood. With a growing interest in exploring security issues related to environmental health, public health and safety officials must be familiar with various aspects of this diverse topic. Environmental health security (EHS) involves sustaining a way of life, in the immediate and long term, and developing a capacity to control or avoid the environmental conditions and consequences that threaten it. Achieving this outcome is complicated and requires a concerted examination into current public and environmental policies and practices.

Responses from 78 DomPrep readers in an August 2014 flash poll related to a companion article, Call for a Dedicated Environmental Health & Security Strategy, revealed a broad range of opinions on and mixed reactions to the complicated topic of EHS. The first question asked, “How would you define environmental health?” Some readers prefer a broad definition, some expressed an interest in narrowing the topic to avoid too much overlap with issues already addressed in public health and security models, and some do not see a need for it to be separated from current public health strategies.

One respondent stated that, “Environmental health is man’s first line of defense against disease agents and risk factors with potentially negative health and safety impacts.” The following definition of environmental health is a compilation of the poll responses received:

Environmental health is the condition of the ecosystem, which is determined by integrating public health and environmental sciences to discover links between the environment – both natural and built – and human health in order to mitigate the long-term effects of air, water, land, and meteorological hazards as well as human activities on the ecosystem as a whole or in part.

A National Environmental Health Security Strategy
Separate national environmental health strategies exist or are being developed in some countries – for example, United States, Australia, and United Arab Emirates, but these do not adequately address the short- and long-term EHS-related issues and largely envelops environmental health as a component of the public health system. Many of the flash poll respondents (nearly 60 percent) agree that EHS in the United States should not be confined within the current National Health Security Strategy (Figure 1). However, it is important to note that at least one respondent in each of the three response groups stated that they agree that it should be “contained” in this strategy, but not “confined” to it.

Of those who answered “Yes” (almost 30 percent), the overlap and interconnectedness of environmental health and public health were the primary reasons provided. According to one respondent, “The two can’t be separated. An unhealthy population is more likely to become unstable and more of a threat than a strength.” Another respondent stated, “As it is now, it crosses into several of the ESFs [Emergency Support Functions] and needs to be better defined with clear responsibilities outlined, taking into consideration the considerable overlap and need for coordination and the ability to prioritize ‘modifiable’ environment-related factors realistically amenable to change using available technologies, policies, and preventative practices.”

Trust and ability to address and respond to these complex threats is another area of concern. Although in agreement that it should be confined, one respondent does not “trust our current government for any honesty or truthfulness.” Because trust is difficult to build yet easy to lose, this concern can only be addressed through open dialogue and established relationships over time.

Of those who answered “No” (nearly 60 percent), many expressed the need for a multiagency – including public health, atmospheric/earth science, industry, public sector, and private sector – and/or multijurisdictional approach to be able to address the industry complexities and broad range of environmental health concerns at the local, state, and federal levels. These can be summed up in the following two responses: “The [existing] national framework can’t possibly cover them all”; and “If we value the environment enough to commit a strategy to protecting it, then it should stand on its own.” Another respondent pointed out the need to better educate the general population to know what to look for and how to provide valuable information to improve the detection process.

Elements of a National Environmental Health Security Model
Environmental health is a fairly well explored and defined discipline. Yet, where the discipline fits into the broader context of national welfare and security needs further consideration. Before developing any new EHS model or strategy, it is important to review any documentation that already exists. For example, the U.S. Environmental Protection Agency (EPA) provides reference lists of laws and executive orders as well as regulations, compliance, enforcement, and guidance documents. These EPA references, the U.S. Geological Survey’s Environmental Health Science Strategy, and other information provide a foundation for further advancement in the field of environmental health.

However, existing environmental health policies may not adequately address the security-related issues and a separate national EHS model should be considered. The respondents shared the following list of elements that should be included in a national EHS model:

Coordination of the healthcare and public health, food and agriculture, water, energy, nuclear, and chemical sectors;

Standards and regulations – including biological research and control; air and water quality; food and beverage imports; guidelines to develop, grow, stabilize, and maintain environmental health; solid waste management; building codes on the federal, state, and local levels;

Rapid response – including stabilization of the environment, minimal expansion of environmental catastrophes, disease control, decontamination, and removal of hazards from the environment; and

Mitigation – including resilience building through education, training using the National Incident Management System and Incident Command System, comprehensive national land and water use plan, national public education program, climate-friendly national energy program emphasizing renewable energy, responsible environmental stewardship, and resource conservation and sustainability.

With so many threats to assess and monitor, it is important for authorities within each community to determine an “acceptable” level of risk, which may change over time, and to adjust their plans accordingly. The model should be scalable, beginning at the local level within each community and increasing to the national level, when incidents affect very large numbers of people or large geographical areas. The model also should consider environmental threat vulnerabilities of operations and systems necessary for food and water supply production and transportation, wastewater treatment, air and soil quality, and energy production.

Emergency Support Functions & Environmental Health
The U.S. Department of Health and Human Services defines emergency support functions (ESFs) as “the grouping of governmental and certain private sector capabilities into an organizational structure to provide support, resources, program implementation, and services that are most likely needed to save lives, protect property and the environment, restore essential services and critical infrastructure, and help victims and communities return to normal following domestic incidents.” When asked if an ESF dedicated to environmental health would be appropriate, the majority of respondents (more than 72 percent) reported, “Yes” (Figure 2).

One respondent noted that public health and environmental health funding are often reduced when budgets are cut because of “the invisible nature of the impacts of the fields – disasters averted, illnesses prevented, and negative economic impacts prevented all go unrecognized.” Unfortunately, this puts additional burden on response agencies such as fire, law enforcement, and emergency medical services. As a large undertaking with various elements, environmental health could benefit from a separate ESF by focusing attention on, raising awareness of, and inspiring more thorough and timely effort toward the topic and possible resolutions. Costa Rica was suggested as a good example of a country that has one such program that already is effective and self-sufficient.

By collaborating with environmental health specialists, already-established environmental health services in each state, emergency preparedness, the U.S. Public Health Service, and public health professionals at the local, state, national levels, new strategies can build on effective work of existing environmental health and safety programs. A new “environmental health” ESF may not be necessary but, according to one respondent, there needs to be “some way to manage contamination mitigation in a coordinated fashion.” After all, “a single event can be made exponentially worse if environmental health is ignored or not considered during the response.”

Approximately 20 percent of respondents reported that a separate ESF is not appropriate. One of these responses points to the response timeframe as a key factor in answering this question:

“Environmental health should be in the National Protection, Prevention, Mitigation, and Recovery Frameworks as we want to keep these natural systems functioning at all times and restore them as quickly as possible. The ESFs in the National Response Framework are there to ensure immediate and continuing provision of essential services during an emergency. As stated in the question, EHS is very complex and, I will add, time consuming to deal with. While EHS is very important to our society in the long term, emergencies are time dependent. The current ESFs include provisions for protecting people and the environment in the short-term.”

Looking Ahead
Multidiscipline planning with an emphasis on EHS would help maintain a balance within the ecosystems by limiting factors that could have potentially devastating effects on human health, safety, and long-term welfare of the nation. According to one respondent, “When mankind designs infrastructure, it must take into account how it most likely will impact the natural balance of an ecosystem either negatively or positively. There must be a commonsense, in-depth analysis, and study over a long period of time on how a specific ecosystem may or may not be disrupted. The infrastructural design must allow the environment to accept the intrusion and be capable of responding positively.”

EHS is not just about responses to immediate incidents. EHS ultimately means sustaining a way of life by developing a capacity to control or avoid the environmental conditions and consequences that threaten it. Addressing immediate and long-term EHS issues will require strategic approaches, multidiscipline cooperation, and changes to policy and practice at all levels of government and industry. But, before that can occur, the long-term outcomes – such as the sufficient supply of food, energy, and water for the population – that contribute to overall and sustained welfare and security of the nation must be determined. With an understanding of the overall goals, jurisdictions can begin planning, resourcing, and undertaking the short-term objectives that cumulatively and strategically work to achieve the long-term outcomes.

This collection of DomPrep materials starts the process of understanding and defining environmental health security. However, this is just a beginning to a much longer process necessary to secure the nation from environmental threats and ensure the welfare of its people.

Catherine Feinman joined Team DomPrep in January 2010. As the editor, she works with writers and other contributors to build and create new content. With more than 25 years experience in publishing, she previously served as journal production manager for Bellwether Publishing Ltd. She also volunteers as an emergency medical technician, firefighter, secretary of the Citizen Corps Council of Anne Arundel County and City of Annapolis, and a Community Emergency Response Team (CERT) trainer.